Hospital Pharmacy - June 2017 - 441
441
Sarangarm et al
Table 2. Demographic Comparison of Study Groups.
All-cause 30-day ED return
Age
Male gender
Has a PCP
English
Single
Ethnicity
Caucasian
Hispanic
Native American
African American
Insurance
Self-pay
Public
Private
Institutional
Reason for initial visit
Pain
Respiratory illness
Skin/wound care
UTI
Other
Medicationa
Antibiotics
Ibuprofen
Methocarbamol
Albuterol
Prednisone
Phenergan
Other
All subjects (n = 711)
THM (n = 268)
SPP (n = 443)
100 (15%)
41 ± 15
334 (47%)
281 (40%)
615 (87%)
493 (69%)
53 (20%)
40 ± 14
132 (49%)
99 (37%)
241 (90%)
199 (74%)
56 (13%)
42 ± 16
202 (46%)
182 (41%)
374 (84%)
294 (66%)
171 (24%)
361 (51%)
66 (9%)
28 (4%)
64 (24%)
130 (49%)
29 (11%)
11 (4%)
107 (24%)
231 (52%)
37 (8%)
17 (4%)
261 (37%)
208 (29%)
105 (15%)
137 (19%)
115 (43%)
67 (25%)
31 (12%)
55 (21%)
146 (33%)
141 (32%)
74 (17%)
82 (19%)
198 (28%)
101 (14%)
122 (17%)
102 (14%)
188 (26%)
45 (17%)
52 (19%)
65 (24%)
32 (12%)
74 (28%)
153 (35%)
49 (11%)
57 (13%)
70 (16%)
114 (26%)
392 (55%)
191 (27%)
45 (6%)
49 (7%)
51 (7%)
50 (7%)
29 (4%)
176 (66%)
39 (15%)
25 (9%)
33 (12%)
19 (7%)
13 (5%)
11 (4%)
216 (49%)
152 (34%)
20 (5%)
16 (4%)
32 (7%)
37 (8%)
18 (4%)
P value
.01
NS
NS
NS
NS
NS
NS
.02
<.01
<.01
<.01
.01
<.01
NS
NS
NS
Note. THM = Take Home Medication; SPP = standard paper prescription; ED = emergency department; NS = nonsignificant; PCP = primary care provider;
UTI = urinary tract infection.
a
Because of overlap in medication use, each medication was its own variable.
hospital or ED visits.16,17 However, neither of these studies
addressed the effect of dispensing medication packs on ED
recidivism. Lark and Phillips examined the effect of providing 3 day starter packs of antibiotics in the ED and found
only 48% of patients receiving these packs ultimately
obtained the follow-up prescription from either a general
practitioner or hospital pharmacy.15 Similarly, Lam et al
found that among patients provided a full antibiotic course to
take at home, 9% reported taking none of the medication,
while an additional 22% stated they did not complete the full
medication course.13 Another study reported no difference in
adherence rates for patients given a complete antibiotic
course rather than prescription.14 A study by Ginde et al
showed only 74.2% of patients given paper prescriptions
actually filled them but found no difference in recurrent ED
visits or hospitalizations when compared with patients given
a complete 5-day course of azithromycin dispensed from the
ED.5 More recently, Hayes et al demonstrated a 50% reduction in return ED visits for specific conditions when patients
were discharged with "to-go" antibiotics.18
Our findings differ from those found in the recent study
by Hayes et al.18 Both studies were performed in urban
academic settings in which provision of THMs is at the discretion of the primary provider rather than strictly protocoldriven. However, there are also several differences in
design between the 2 studies. The Hayes study used a retrospective approach, using a convenience sample, with a follow-up period of 7 days. In contrast, the current study was
prospective, reviewed all patients seen in the ED during the
study period for eligibility, and used a 30-day follow-up
window. While Hayes et al looked at antibiotics and a specified set of diagnoses, we included all available THMs and
did not proscribe specific diagnoses. For comparison to the
Hayes study, we re-ran an analysis of our data looking at
Table of Contents for the Digital Edition of Hospital Pharmacy - June 2017
Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
ISMP Medication Error Report Analysis
Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Formulary Drug Reviews: Plecanatide
Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
Financial Effect of a Drug Distribution Model Change on a Health System
Limited Influence of Excipients in Extemporaneous Compounded Suspensions
Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
Hospital Pharmacy - June 2017 - 381
Hospital Pharmacy - June 2017 - 382
Hospital Pharmacy - June 2017 - 383
Hospital Pharmacy - June 2017 - 384
Hospital Pharmacy - June 2017 - 385
Hospital Pharmacy - June 2017 - 386
Hospital Pharmacy - June 2017 - 387
Hospital Pharmacy - June 2017 - Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
Hospital Pharmacy - June 2017 - 389
Hospital Pharmacy - June 2017 - ISMP Medication Error Report Analysis
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Hospital Pharmacy - June 2017 - Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
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Hospital Pharmacy - June 2017 - Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
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